Medical-Clinical Support-Nursing - LPN
The Medical Review Nurse LPN position at Florida Blue involves reviewing, authorizing, coordinating, and responding to service requests from members The role requires telephonic communication with providers, offices, and occasionally with members.
The Medical Review Nurse LPN makes decisions based on established policies, procedures, medical coverage guidelines, benefits, InterQual criteria, and nursing knowledge.
Cases that may require denial are referred to the medical directors.
Essential functions of the job include performing medical record reviews, abstracting HEDIS data, and collaborating with the HEDIS STARs Team and Quality Team.
Administrative tasks, such as medical record requests, faxing, and calls to members and providers, are also part of the role.
The position requires tracking, monitoring, and reporting on record status and workload volume.
Completing claim research to identify service details, conducting prior authorization, and assisting with the prior authorization process are important responsibilities.
The Medical Review Nurse LPN must collaborate with various Florida Blue departments, maintain documentation, and log into the phone queue to service providers.
Professional and accurate handling of inbound calls, along with providing information to provider offices, is essential.
Job requirements include knowledge of medical terminology, experience with prior authorization, familiarity with InterQual criteria and Medicare regulations, and proficiency in Microsoft Office.
Strong communication, organizational, problem-solving, and time management skills are necessary.
The ability to navigate multiple systems, think analytically, and handle a large workload is expected.
Preferred qualifications include disease management experience and recent experience in medical record reviews and HEDIS/Stars data collection.
The minimum requirement is a high school diploma or GED, 2
years of related work experience, and LPN state licensure.
Recommended Skills Administration Communication Data Collection Disease Management Medical Records Medical Terminology Estimated Salary: $20 to $28 per hour based on qualifications.
The Medical Review Nurse LPN makes decisions based on established policies, procedures, medical coverage guidelines, benefits, InterQual criteria, and nursing knowledge.
Cases that may require denial are referred to the medical directors.
Essential functions of the job include performing medical record reviews, abstracting HEDIS data, and collaborating with the HEDIS STARs Team and Quality Team.
Administrative tasks, such as medical record requests, faxing, and calls to members and providers, are also part of the role.
The position requires tracking, monitoring, and reporting on record status and workload volume.
Completing claim research to identify service details, conducting prior authorization, and assisting with the prior authorization process are important responsibilities.
The Medical Review Nurse LPN must collaborate with various Florida Blue departments, maintain documentation, and log into the phone queue to service providers.
Professional and accurate handling of inbound calls, along with providing information to provider offices, is essential.
Job requirements include knowledge of medical terminology, experience with prior authorization, familiarity with InterQual criteria and Medicare regulations, and proficiency in Microsoft Office.
Strong communication, organizational, problem-solving, and time management skills are necessary.
The ability to navigate multiple systems, think analytically, and handle a large workload is expected.
Preferred qualifications include disease management experience and recent experience in medical record reviews and HEDIS/Stars data collection.
The minimum requirement is a high school diploma or GED, 2
years of related work experience, and LPN state licensure.
Recommended Skills Administration Communication Data Collection Disease Management Medical Records Medical Terminology Estimated Salary: $20 to $28 per hour based on qualifications.
|
|
 | |
